Take the window bed - even in the Matrix. The Ecocebo effect

 

 

We've all heard of the Placebo effect. But a recent paper by Zandonai & Chiamulera highlighted the "Ecocebo" effect, where a patient’s environment, perceived or real, has a measurable impact on drug effectiveness. This implies that clinical trials should aim for consistency in environment, but also it may open another aspect of therapy.

 

What is an Ecocebo?

It could be defined as a placebo-like effect from one's immediate environment. A variation on this is "neuroarchitecture", the cognitive and emotional response to the built environment, reviewed in Higuera-Trujillo et al, (2021).

So, some examples

A pioneering study by Roger Ulrich published in 1984 compared post-surgical outcomes between two groups with a simple difference - half had windows with natural scenery and light, the other half had windows facing brick walls. The first group not only recovered better, they took less strong medication.

Natural light does seem to be an important factor. Walch et al. (2005) found that spinal surgery patients exposed to high-intensity sunlight required 22% less pain medication per hour, and had 21% less pain medication costs, compared to those in low-light conditions.

Beyond this, in general what gives pleasure helps the patient, and what causes stress does not. But quantifying how to achieve this is not necessarily easy, although it can be done. To take a specific example, Bar and Meta (2007) found curved furniture to be preferred to furniture with sharp corners, and hypothesised this is due to a threat perception as the amygdala is preferentially stimulated by the presence of sharp edges. However, it does seem to be a general pattern, Vartanian et al (2013) showed that not only did subjects prefer curved rooms rather than rectangular rooms with corners, but the curvilinear rooms preferentially activated the anterior cingulate cortex, a region associated with the emotional perception of pain. 

 

Study of the Ecocebo effect - Virtual Reality

Obviously, it is somewhat difficult to build hospital wards specifically for such a study. However, Zandonai & Chiamulera argue that improvements in virtual reality (VR) technologies do present an alternative, being sufficiently "immersive" to fool the brain. Readers have doubtless seen how even watching a good movie can elicit different emotional responses.

Mimicking the original study, volunteers suffering chronic migraines were subjected to a laser pain stimulus when immersed in either a standard hospital waiting room, or an "ideal" room with a sea view. Those lucky enough to get the sea view reported less pain (Tommaso et al 2013).

Following on from this, Presti et al (2022) generated a VR system that presented different architectural features to volunteers, causing varying emotional responses, and this is just one example.

VR therefore would appear to have possibilities for study of beneficial medical environments, or indeed as a treatment itself.

Care should be taken with this technique though. Marín-Morales et al (2021), monitored subjects as they walked through a museum exhibit on the Holocaust, and an identical VR equivalent. Both groups self reported very similar emotional responses, but the VR group had considerably less heart rate variation and vagal stimulation. As Zandonai & Chiamulera comment, the "sense of presence" is subjective, variable, and difficult to quantify.

 

References

Bar, M., Neta, M. (2007). Visual elements of subjective preference modulate amygdala activation. Neuropsychologia, 45, 2191–2200.

Higuera-Trujillo, J. L., Llinares, C., & Macagno, E. (2021). The Cognitive-Emotional Design and Study of Architectural Space: A Scoping Review of Neuroarchitecture and Its Precursor Approaches. Sensors, 21(6), 2193. https://doi.org/10.3390/s21062193. 

Marín-Morales J, Higuera-Trujillo JL, Guixeres J, Llinares C, Alcañiz M, Valenza G. (2021). Heart rate variability analysis for the assessment of immersive emotional arousal using virtual reality: Comparing real and virtual scenarios. PLoS One, 16(7):e0254098. doi: 10.1371/journal.pone.0254098.

Presti P, Ruzzon D, Avanzini P, Caruana F, Rizzolatti G, Vecchiato G. (2022). Measuring arousal and valence generated by the dynamic experience of architectural forms in virtual environments. Sci Rep., 12(1):13376. doi: 10.1038/s41598-022-17689-9.

de Tommaso M, Ricci K, Laneve L, Savino N, Antonaci V, Livrea P. (2013). Virtual visual effect of hospital waiting room on pain modulation in healthy subjects and patients with chronic migraine. Pain Res Treat., 2013:515730. doi: 10.1155/2013/515730.

Ulrich, R.S. (1984). View Through a Window May Influence Recovery from Surgery. Science, 224, 420-424.DOI:10.1126/science.6143402.

Vartanian, O., Navarrete, G., Chatterjee, A., Fich, L.B., Leder, H., Modroño, C., Nadal, M., Rostrup, N., Skov, M. (2013). Impact of contour on aesthetic judgments and approach-avoidance decisions in architecture. Proc. Natl. Acad. Sci. USA, 110, 10446-10453.

Walch, J.M., Rabin, B.S., Day, R., Williams, J., Choi, K., Kang, J. (2005). The effect of sunlight on postoperative analgesic medication use: A prospective study of patients undergoing spinal surgery. Psychosom. Med., 67, 156-163.

Zandonai, T., & Chiamulera, C. (2025). The Interplay Between Environment and Drug Effects: Decoding the Ecocebo Phenomenon with Virtual Technologies. Sensors, 25(17), 5268. https://doi.org/10.3390/s25175268

Ultrafine particles and human health

Photo by Sarah Stephen

We recently highlighted a crucial study that showed the threat posed by ultrafine particles (UFPs) on pregnant women living near airports. You can access it here in the Medium.
 https://medium.com/@ruthstephen/the-dangers-of-aircraft-emissions-exposure-during-pregnancy-6ee57e9a1331

Ultrafine particles are the smallest of atmospheric particles ( ≤0.1 µm in diameter). UFPs show unique physical and aerodynamic properties that are distinct from larger particles within the PM2.5 size range. Although UFPs account little in terms of particle mass, they constitute the majority of particles and surface area.

In fact, UFPs on an equal mass basis may have higher impact on health than PM2.5 and PM10 as unlike the larger particles that are removed by the body’s usual surveillance and clearance mechanisms, UFPs have the remarkable ability to escape inbuilt checkpoints.

This is because their small size facilitates easy entry of the UFPs into the thin membranes of the lung during inhalation and could enter the circulation and can be carried by the blood to distant parts of the body, including the placenta. They have even been shown to be transported to the brain via the olfactory nerve.

Another unique trait of the UFPs is their ability to trap and transport other harmful chemicals in the atmosphere, such as polyaromatic hydrocarbons that are by products of automobile emissions, which could then lead to inflammation and associated detrimental health effects.

They too serve, who plough our lands

“For the sweat they put into farming, farmers get very little rewards.”

Amidst the pandemic, there is one group of unsung essential workers - the farmers. They put food on our tables and keep us moving. Living in rural England, I regularly witness how much they contribute to our existence. Whilst, the country has almost come to a standstill, I observe life going on as normal in the fields.

During my daily walk as part of my exercise, I see  farm machinery ploughing the fields, yet others sowing, and am hopeful of also seeing the mighty combine harvesters  bringing

in the crop in the future- a sign that everything will be all right. I see hedgerows that form beautiful chequered patterns on the fields, and verges on the sides of the fields faithfully managed, so that wildlife can thrive. In my walks, I often see pheasants, quails, hares, and rabbits. The scene could be almost from a Constable painting, only with modern implements, set to the tune of Gerald Finzi’s ‘Eclogue’.

Life can be often tough for the farmers. In the last two decades, diseases like BSE, foot and mouth disease, and bovine TB have wreaked great havoc on UK farmers. Farmers are also frequently victims to adverse weather situations like floods and dry summers. To top it all, is the lack of profit in farming. For the sweat they put into farming, farmers get very little rewards. An independent study showed that farmers make more from subsidies than from profit.Whilst, they may appear to be a steely bunch, several studies show that farmers worldwide are at severe risk for mental health disorders.

Farmers not only provide the food we eat, they also manage wildlife habitats. Farmlands constitute the majority of our countryside. They are stewards of what makes our country ‘green and pleasant’. We really need to support them during and post-pandemic.

References:

1. https://fullfact.org/economy/farming-subsidies-uk/

2. Research trends in farmers' mental health: A scoping review of mental health outcomes and interventions among farming populations worldwide. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225661

COVID -19 outbreak highlights human-wildlife conflict

Whilst most of the world is engaged in containing and preventing COVID-19, the coronavirus, infection, a key question remains unanswered- identifying the original source of the infection. Early investigations pointed to a fish market in Wuhan province in China, which also traded in live wildlife. The hypothesis is that the infection arose from animal X in the market that was traded in the market, a carrier of the virus (1). The virus had jumped species and then infected humans. Scientists are scrambling to identify the animal. Recently published research show that coronavirus in pangolin, the scaly anteater, is 99% identical to that found in the humans (2, 3). Pangolins are prized in Chinese medicine to the extent that they are in the brink of extinction (4,5). Amongst other wildlife traded in the infamous market traded also were live pangolins and pangolin parts. However, researchers are unable to prove conclusively that pangolins are the source of the infection. So the quest continues.

COVID-19 outbreak is an example of what happens when the finely tuned relationship between humans and wildlife is jeopardized. We have repeatedly highlighted human wildlife conflict in the pages of Ecoratorio(6,7) . Many animals, particularly wildlife are reservoirs of viruses and have co-existed in this manner for ages. However, when humans upset the fragile balance by encroaching the habitats of the wildlife which make either party enter the abode of the other, or when wildlife/wildlife parts are traded, these zoonotic viruses can infect humans. Regardless of whether pangolins are the source of the COVID 19 infection, the outbreak yet again points to the persistent sore that has remained untreated-wildlife trade. Indisputably, there are environmental and ethical reasons why wildlife must be respected. A blanket ban on trading wildlife should be enforced, not only on the trade of wildlife animals for consumption but also on their use in traditional medicine. Similarly, encroachment into wildlife habitats and deforestation should be prevented. Otherwise, calamitous consequences like the current COVID 19 would be commonplace.

References

1.https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

2. https://www.nature.com/articles/d41586-020-00364-2

3. https://www.nature.com/articles/d41586-020-00548-w

4.https://www.nature.com/articles/141072b0

5 https://www.nationalgeographic.com/magazine/2019/06/pangolins-poached-for-scales-used-in-chinese-medicine/

6. http://ecoratorio.blogspot.com/2011/07/fine-line.html

7. http://ecoratorio.blogspot.com/search?q=virus

Climate change will affect the distribution and diversity of marine organisms

Climate change will force marine organisms towards the poles, but would they be safe there? 

Human activities such as emissions from the use of fossil fuels, rampant urbanisation, deforestation, and modern agricultural practices, are all altering the earth’s climate in an unprecedented scale. Climate change not only occurs in the land, but also in water bodies. Studies have indicated that since the 1950s, the amount of heat stored in the ocean (ocean heat) has increased considerably. Besides, ocean temperatures have increased throughout the world since the advent of the twentieth century, with the past three decades recording the highest temperatures since the measurements began.

 A major consequence of increase in ocean temperatures is the corresponding decrease in dissolved oxygen levels. This phenomenon is predicted to significantly disturb marine ecosystems. Recent research by a group of American and German scientists revealed the consequences of oceanic climate change on a range of fish and crustacean species in the North Atlantic with different levels of tolerance towards heat and oxygen levels. The researchers'  climate models predict substantial warming and deoxygenation throughout most of the upper ocean by the end of this century which in turn will affect the distribution  of marine  creatures. Their studies reveal that warming of water and oxygen depletion would force the organisms to migrate towards the pole due to deficiency of the original native waters to sustain their energy requirements. The scientists predict that even the waters towards the pole would have reduced oxygen levels, meaning the survival of the migrants could be precarious even there. Furthermore, this movement could alter the ecosystems in the polar waters due to many factors including competition from the migrants which may alter species ecologies.

References

http://www.sciencemag.org/content/348/6239/1132.abstract

Deutsch C, Ferrel A, Seibel B, Pörtner HO, & Huey RB (2015). Ecophysiology. Climate change tightens a metabolic constraint on marine habitats. Science (New York, N.Y.), 348 (6239), 1132-5 PMID: 26045435